Allergic history. Allergic history becomes the first stage of diagnostics, it is formed simultaneously with the clinical history

Ecology changes environment, the avalanche-like increase in the amount of synthetic substances, including medicines and food components, has significantly expanded the contingent of the population suffering from allergic diseases. Allergization of the population is largely promoted by the uncontrolled use of medications for self-medication. Allergic history (AA) became an essential part of the medical history.

The main goals of AA are to elucidate possible reactions to the use of drugs, changes clinical manifestations infections with concomitant allergic reactions, as well as differential diagnosis of allergic diseases with syndromic infectious diseases, especially those accompanied by exanthema.

First of all, the facts of intolerance to antibiotics and other medicines, the presence of reactions to vaccinations in the past, intolerance to certain foods (milk, chocolate, citrus fruits, etc.) are subject to clarification. Particular attention is paid to the use of earlier drugs with increased sensitization properties of the body (heterogeneous sera, antibiotics, in particular ampicillin, etc.). Various clinical forms of allergic diseases (hay fever, bronchial asthma, Quincke's edema, urticaria, Lyme disease, etc.), since these patients should be attributed to the group at increased risk of severe allergic reactions.

When assessing an allergic anamnesis, one should take into account the fact that some diseases (brucellosis, intestinal yersiniosis, pseudotuberculosis, trichinosis and some other helminthic invasions) sometimes occur with a pronounced allergic component, and focal infections (odontogenic, tonsillogenic) contribute to the allergization of the body.

In cases of a successful allergic anamnesis, it is permissible to limit yourself to a record " There were no allergic diseases and reactions, food and drug intolerance in the past. "

5.5. Anamnesis of life

This section of the medical history should give a kind of socio-biological characteristics of the patient as a subject of examination, the result of which should be a diagnosis of the disease, an assumption about its possible prognosis. In fact, it reflects the well-known position on the role of social factors in morbidity.

The life history includes information about the living conditions, the nature and characteristics of the patient's work. Living or serving in the past in unsafe areas in sanitary and hygienic terms or in natural foci of infections can suggest a certain group of diseases (drip, viral hepatitis A, malaria, encephalitis, hemorrhagic fever, etc.) Service in unfavorable climatic conditions, on submarines helps to reduce the body's resistance.

For the spread of some diseases, the conditions of accommodation and living of people - hostels - are important. barracks (diseases of meningococcal infection, diphtheria with great crowding, outbreaks of acute intestinal infections in cases of lack of sanitary and hygienic conditions in accordance with epidemiological requirements).

Clarification of the specifics of the conditions of service activity, the nature of professional work can reveal the influence of adverse specific factors (chemical, radiation, microwave exposure, chronic occupational and environmental stress, etc.) on the susceptibility to a particular infection, as well as on the severity of its course.

Allergic diseases are polygenic diseases - both hereditary factors and factors play a role in their development external environment... This was formulated very clearly by I.I. Balabolkin (1998): “According to the ratio of the role of environmental hereditary factors in pathogenesis allergic diseases are referred to a group of diseases, the etiological factor for which is the environment, but at the same time a hereditary predisposition has a significant effect on the frequency of occurrence and severity of their course ”.

In this regard, for allergic diseases standard circuit medical history is supplemented by the section "Allergic history", which can be conditionally divided into two parts: 1) genealogical and family history and 2) history of hypersensitivity to external influences(allergenic history).

Genealogical and family history... Here it is necessary to find out the presence of allergic diseases in the pedigree of the mother and father, as well as among the family members of the patient.

For clinicians, the following guidelines are essential: hereditary burden on the part of the mother in 20-70% of cases (depending on the diagnosis) is accompanied by allergic diseases; on the father's side - much less, only in 12.5-44% (Balabolkin I.I., 1998). In families where both parents suffer from allergic diseases, the rates of allergic morbidity in children are 40-80%; only one of the parents - 20-40%; if brothers and sisters are sick - 20-35%.

And mmu but genetic studies have laid the foundation for a hereditary predisposition to allergic diseases (atopy). The existence of a genetic system for nonspecific regulation of the IgE level, carried out by the genes of the excessive immune response - Ih-genes (immune hyperresponse), has been proved. These genes are associated with antigens of the major histocompatibility complex A1, A3, B7, B8, Dw2, Dw3, and high level IgE is associated with haplotypes A3, B7, Dw2.

There is evidence of a predisposition to specific allergic diseases, and this predisposition is supervised by different antigens of the HLA system, depending on the nationality.

For example, a high predisposition to hay fever in Europeans is associated with the HLA-B12 antigen; among Kazakhs - with HLA-DR7; among Azerbaijanis - with HLA-B21. At the same time, immunogenetic studies in allergic diseases cannot yet be specific guidelines for clinicians and require further development.

Allergenic history... This is a very important section of diagnostics, as it allows you to get information about the most possible reason the development of an allergic disease in a particular patient. At the same time, this is the most laborious part of the anamnesis, since it is associated with big amount various environmental factors that can act as allergens. In this regard, it seems appropriate to give a specific survey algorithm based on the classification of allergens.

Food allergens... Especially carefully the dependence on food allergens should be found out in case of allergic skin diseases and gastrointestinal tract.

It should also be remembered that food allergies are most common in children, especially those under 2 years of age.

“As with other types of allergies, with food allergies the quality of the allergen is critical, but the quantity of food allergens cannot be underestimated. The prerequisite for the development of the reaction is the excess of the threshold dose of the allergen, which happens when there is a relative excess of the product in relation to the digestive capacity of the glands of the "intestinal tract." medical and preventive programs for food allergies.

Almost any food product can be an allergen, but the most allergenic cow's milk, chicken eggs, seafood (cod, squid, etc.), chocolate, nuts, vegetables and fruits (tomatoes, celery, citrus fruits), seasonings and spices, yeast, flour. V recent times Allergens associated with additives and preservatives that increase the shelf life of foreign-made food products are quite widespread. If these additives were used in domestic products, they also caused an allergic reaction in persons sensitive to them, and these people served as indicators of the presence of foreign impurities in domestic food. We have given this type of allergy the codename “patriotic allergy”.

Cross-allergy is possible within the same botanical family: citrus fruits (oranges, lemons, grapefruits); pumpkin (melons, cucumbers, zucchini, pumpkins); mustard (cabbage, mustard, cauliflower, Brussels sprouts); nightshades (tomatoes, potatoes); pink (wild strawberries, strawberries, raspberries); plums (plums, peaches, apricots, almonds), etc. You should also dwell on meat products, especially on poultry meat. Although these products do not have a great sensitizing activity, antibiotics are included in the diet of birds before slaughter, and it is they that can cause allergic diseases that are no longer associated with food, but with drug allergies. When it comes to flour, it is more common for flour to become an allergen by inhalation, rather than by ingestion.

Indications for heat treatment are important in collecting this anamnesis, since heat treatment significantly reduces the allergenicity of food.

House dust allergens... These allergens are most significant for allergic respiratory diseases, in particular, bronchial asthma. The main house dust allergens are the chitinous cover and waste products of house mites Detmatophagoides pteronyssimus and Derm. Farinae. These mites are widespread in beds, carpets, upholstered furniture, especially in older homes and old bedding. The second most important house dust allergens are mold fungi (usually Aspergillus, Alternaria, PeniciUium, Candida). These allergens are most often associated with damp, unventilated rooms and warm seasons (April-November); they are also part of library dust allergens. The third in importance in this group are the allergens of domestic animals, and the most sensitizing ability is possessed by cat allergens (dandruff, hair, saliva). And, finally, house dust includes insect allergens (chitinous cover and cockroach excrement); daphnia, used as dry fish food; bird feather (pillows and featherbeds, especially with goose feathers; parrots, canaries, etc.).

Plant allergens... They are primarily associated with hay fever, and the main place here belongs to pollen, and most often the etiological factor of hay fever is the pollen of ragweed, wormwood, quinoa, hemp, timothy grass, rye, plantain, birch, alder, poplar, hazel. Common antigenic properties (cross-allergy) are possessed by pollen of cereals, mallow, wormwood, ragweed, sunflower, pollen of birch, alder, hazel, poplar, aspen. These authors also note the antigenic relationship between the pollen of birch, cereals, and apples.

Insect allergens... The most dangerous are insect poisons (bees, wasps, hornets, red ants). However, allergic diseases are often associated with saliva, excrement and secretions of the protective glands of blood-sucking insects (mosquitoes, gnats, horseflies, flies). More often, allergic diseases associated with these allergens are realized in the form skin manifestations, however (especially the poison of bees, wasps, hornets, ants) can also cause severe conditions (angioedema, severe bronchospasm, etc.) up to anaphylactic shock and death.

Medicinal allergens... Anamnesis in this direction must be collected very carefully, since this is not only a diagnosis of an allergic disease, but, first of all, it is the prevention of a possible death due to the unexpected development of anaphylactic shock. There is no need to convince that this type of allergic history should become a mandatory tool for all clinicians, since cases of anaphylactic shock and deaths with the introduction of novocaine, radiopaque substances, etc.

Since drugs are usually relatively simple chemical compounds, they act as haptens, connecting with body proteins to a complete antigen. In this regard, allergenicity medicinal substances depends on a number of conditions: 1) the ability of the drug or its metabolites to conjugate with a protein; 2) the formation of a strong bond (conjugate) with the protein, resulting in the formation of a complete antigen. Very rarely, an unchanged drug can form a strong bond with a protein, more often this is due to metabolites formed as a result of biotransformation of a drug. It is this circumstance that determines the rather frequent cross-sensitization of medicinal substances. L.V. Luss (1999) cites the following data: penicillin gives cross reactions with all drugs of the penicillin series, cephalosporins, sultamicillin, sodium nucleinate, enzyme preparations, a number of food products (mushrooms, yeast and yeast-based products, kefir, kvass, champagne); sulfonamides cross-react with novocaine, ultracaine, anesthesin, antidiabetic agents (antidiabetic, antibeta, diabeton), triampur, para-aminobenzoic acid; analgin cross-reacts with salicylates and other non-steroidal anti-inflammatory drugs, food containing tartrazine, etc.

In this regard, another circumstance is also important: the simultaneous administration of two or more drugs can interfere with the metabolism of each of them, disrupting it. Metabolic disorders of non-sensitizing drugs can cause allergic reactions on them. L. Yeager (1990) cites this observation: the use of antihistamines in some patients it caused an allergic reaction in the form of agranulocytosis. A careful analysis of these cases made it possible to establish that these patients were simultaneously taking medications that disrupt the metabolism of antihistamines. Thus, this is one of the compelling arguments against polypharmacy and a reason to find out in the allergological history the mutual influence on the metabolism of the drugs used. V modern conditions for the prevention of allergic diseases, the doctor must know not only the names of drugs, indications and contraindications, but also know their pharmacodynamics and pharmacokinetics.

Quite often with the use medicines associated with the development of effects that A.D. Ado singled out into a separate group, which he called pseudo-allergies or false allergies. As already shown, the fundamental difference between pseudo-allergy and allergy is the absence of preliminary sensitization associated with antibodies-reagins (IgE). The clinical effects of pseudoallergy are based on the interaction of chemicals either directly with the membranes of mast cells and basophils, or with cell receptors for IgE, which ultimately leads to degranulation and release of BAB, primarily histamine, with all the ensuing consequences.

It seems important to provide clinical guidelines for differential diagnosis drug allergy and pseudo-allergies. Pseudoallergy more often occurs in women after 40 years of age against the background of diseases that disrupt the metabolism of histamine or the sensitivity of receptors to biologically active substances (pathology of the liver and biliary tract, gastrointestinal tract, neuroendocrine system). The background for the development of pseudoallergy is also polypharmacy, oral administration of drugs for ulcerative, erosive, hemorrhagic processes in the mucous membrane of the gastrointestinal tract; the dose of the drug that does not correspond to the age or weight of the patient, inadequate therapy for the current disease, changes in the pH environment and temperature of solutions administered parenterally, simultaneous administration of incompatible drugs (Luss L. V., 1999). Characteristic clinical signs pseudo-allergies are: the development of the effect after the initial administration of the drug, the dependence of the severity of clinical manifestations on the dose and route of administration, the rather frequent absence of clinical manifestations with repeated administration of the same drug, the absence of eosinophilia.

In conclusion of the section medicinal allergens provides a list of drugs that most often provoke the development of allergic diseases. In this list, which is compiled on the basis of the data given in the works of L.V. Luss (1999) and T.N. Grishina (1998), the principle from larger to smaller was used: analgin, penicillin, sulfonamides, ampicillin, naproxen, brufen, ampiox, aminoglycosides, novocaine, acetylsalicylic acid, lidocaine, multivitamins, X-ray contrast agents, tetracyclines.

Chemical allergens... The mechanism of sensitization by chemical allergens is similar to drug allergens. The most common allergic diseases are caused by the following chemical compounds: salts of nickel, chromium, cobalt, manganese, beryllium; ethylenediamine, rubber products, chemical fibers, photoreagents, pesticides; detergents, varnishes, paints, cosmetics.

Bacterial allergens... The question of bacterial allergens arises in the so-called infectious-allergic pathology of the mucous membranes of the respiratory and gastrointestinal tract and, above all, in infectious-allergic bronchial asthma. Traditionally bacterial allergens subdivided into allergens of pathogens of infectious diseases and allergens of opportunistic bacteria. At the same time, according to V.N. Fedoseeva (1999), “there is a certain convention in terms of pathogenic and non-pathogenic microbe. The concept of pathogenicity should include more wide range properties, including the allergenic activity of the strain ”. This is a very principled and correct position, since diseases are well known, the allergic component in which plays a leading role in pathogenesis: tuberculosis, brucellosis, erysipelas, etc. , staphylococci, colibacillus and etc.).

These microbes, in the presence of certain conditions (genetic predisposition, immune, endocrine, regulatory, metabolic disorders; impact unfavorable factors environment, etc.) can acquire allergenic properties and cause allergic diseases. In this regard, V.N. Fedoseeva (1999) emphasizes that “bacterial allergy plays an important role in the etiopathogenesis of not only particularly dangerous infections, but primarily in focal respiratory diseases, pathologies of the gastrointestinal tract, skin”.

Previously, bacterial allergy was associated with delayed-type hypersensitivity, since a high allergic activity of nucleoprotein fractions of a microbial cell was established. However, back in the 40s. O. Swineford and J.J. Holman (1949) showed that microbial polysaccharide fractions can cause typical IgE-dependent allergic reactions. Thus, for bacterial allergies characterized by a combination of reactions of delayed and immediate types, and this served as the basis for the inclusion of specific immunotherapy (SIT) in the complex of treatment of allergic diseases of a bacterial nature. Currently, "neisserial" bronchial asthma, "staphylococcal" infectious allergic rhinitis etc. A practitioner should know that it is not enough to establish the infectious-allergic nature of the disease (for example, bronchial asthma); it is also necessary to decipher which type of opportunistic flora determines allergization. Only then, using this allergic vaccine in the SIT treatment complex, can a good therapeutic effect be obtained.

Currently, a significant role of dysbiosis in the formation of immunodeficiencies and immune deficiency has been established. From our point of view, mucosal dysbiosis is also one of the significant factors in the etiology of allergic diseases. In the hands of clinicians, there should be not only a method for assessing intestinal dysbiosis, but also methods that allow assessing the norm and dysbiosis of other mucous membranes, in particular the respiratory tract.

The most common etiopathogenetic factors of diseases of an infectious-allergic nature are: hemolytic and green streptococci, staphylococci, catarrhal micrococci, Escherichia coli, Pseudomonas aeruginosa, Proteus, non-pathogenic Neisseria.

Collecting an allergic history begins with clarifying complaints from the patient or his parents, allergic diseases in the past, concomitant allergic reactions. Important information can be obtained when clarifying the developmental characteristics of the child before the onset allergic manifestations, you can find the sources of sensitization and factors contributing to its development. Often this is the mother's excessive consumption of foods with high allergenic activity during pregnancy and lactation, drug therapy mothers during this period and contact with aeroallergens of dwellings in high concentrations.

Exposure to these allergens after childbirth can also cause sensitization of the body.

Information about previous allergic reactions and diseases is essential, which most often indicates the atopic genesis of the developed allergic disease. With indications of allergic reactions and diseases in the past, the results of an allergic examination and the effectiveness of pharmacotherapy and specific immunotherapy in the past are clarified. Positive result antiallergic therapy indirectly confirms the allergic nature of the disease.

Particular attention is paid to the peculiarities of the development of the disease: they find out the time and causes of the first episode of the disease, the frequency and causes of exacerbations, their seasonality or year-round nature. Emergence allergic symptoms in the flowering season of plants indicates hay fever, and their year-round existence may be associated with sensitization to aeroallergens of dwellings. The relationship between exacerbations of allergies and the time of day (day or night) is also being clarified.

Patients with hay fever feel worse in day hours when the concentration of pollen in the air is at its maximum. In children with tick-borne bronchial asthma and atopic dermatitis, the symptoms of the disease are worse in the evening and at night on contact with bedding. Symptoms of allergic diseases caused by tick-borne sensitization (bronchial asthma, allergic rhinitis, allergic conjunctivitis) appear more often at home, and when they change their place of residence or hospitalization, the condition of patients improves. The state of health of such patients worsens when living in old wooden houses with stove heating and high humidity.

In children with diseases caused by sensitization to mold fungi (fungal bronchial asthma, fungal allergic rhinitis), exacerbation of the disease occurs more often when living in damp rooms, near water bodies, in forests with high humidity, in contact with hay and rotten leaves. Living in rooms with a large amount of upholstered furniture, curtains, carpets can increase sensitization to house dust allergens and can cause frequent exacerbations of respiratory and skin allergies.

The association of the occurrence of allergic symptoms with the consumption of certain foods indicates food sensitization. The manifestation of allergic manifestations upon contact with pets, birds, when visiting a circus, a zoo, indirectly indicates sensitization to epidermal allergens. In cases of insect allergy, there is a connection between allergic manifestations and insect bites and contact with insects such as cockroaches. Allergic history can give important information about drug intolerance.

In addition to information characterizing the participation of exogenous allergens in the development of allergic manifestations, anamnesis data allow us to judge the role of infection, pollutants, nonspecific factors(climatic, weather, neuroendocrine, physical) in the development of allergic diseases.

Anamnesis data allow to determine the severity of an allergic disease and to carry out anti-relapse therapy and preventive measures in a differentiated manner, to determine the volume and methods of subsequent allergological examination to establish causally significant allergens.

OOAU SPO "ELETSKY MEDICAL COLLEGE"

SCHEME OF CLINICAL EXAMINATION OF THE PATIENT

AND PLAN FOR WRITING A TRAINING HISTORY OF THE DISEASE

FOR PEDIATRICS

Compiled by the teacher

F.I. Zaitseva

Yelets, 2012

Foreword

Real guidelines are intended to help students of the specialty "General Medicine" in the study of the discipline "Pediatrics with childhood infections", as well as for students who are in industrial practice when writing a case history.

Students of the specialty "General Medicine" must show the ability to examine a patient and describe in detail the results of examination and observation, using all sections of the recommendations, including the isolation of syndromes based on the materials of clinical research.

When studying pediatrics, students need to supervise patients on the topics of the discipline and correctly fill out the educational history of the disease. It is necessary to single out syndromes, consolidating and developing the skills that we got acquainted with when studying propaedeutics in pediatrics, and then substantiate the preliminary diagnosis, draw up an individual plan for further examination. Then, based on the materials of the paraclinical examination, the identified syndromes should be formulated clinical diagnosis within the framework of the accepted classification, draw up the sections "Treatment" and "Diary of observation of the patient." Students must show how they have mastered the techniques of practical diagnostics.

Components of the educational history of the disease:

1. Passport part.

2. Patient complaints upon admission.

3. History of present illness.

4. Anamnesis of the patient's life.

5. Living conditions of the patient.

6. Family history.

7. Allergic history.

8. Epidemiological history.

9. Objective research on systems.

10. Diagnostic process.

11. Preliminary diagnosis

12. Clinical diagnosis

13. Treatment

14. Observation diary

Passport part

1. Surname, name, patronymic of the patient.

2. Age, exact date birth.

3. Place of residence.

4. Place of study.

5. Who sent the patient to inpatient treatment.

6. Diagnosis upon referral.

7. Time of admission to the hospital.

8. Diagnosis on admission.

9. Preliminary diagnosis.

10. Clinical diagnosis.

11. Complications.

2. Patient complaints upon admission

At the beginning, the complaints of the patient or his parents, expressed at the first address to him with the question: "What worries you?" Then carried out detailed description of all complaints about the organ system, the defeat of which seems to be the main one, or from which there is greatest number complaints. It must be remembered that this hypothesis about the predominant defeat of a particular system may not be confirmed in the future. Therefore, further, by means of purposeful questioning, a clear idea of ​​the functioning of all body systems of the supervised patient should be drawn up. The recording of complaints in the medical history should be carried out for each organ system separately. To facilitate this task, the symptomatology of the systems is carried out.

3. History of present illness

The history of the present disease should reflect in detail clinical development diseases from the time of the appearance of the first symptoms to the beginning of supervision. When, with what painful manifestations the disease began and how (suddenly, acutely, gradually). Indicate the alleged causes of the disease by the patient or relatives. When I first went to the doctor, what diagnoses were established earlier.

What medications and therapeutic methods were used, their effectiveness, was it noted side effect medicines (antibiotics, cardiac glycosides, steroid hormones, etc.). How long was treated in a polyclinic, when he was sent to the hospital, when he was hospitalized, the course of the disease before the start of supervision. If the patient is re-hospitalized, find out when, where, how long and by what methods he was treated earlier. The results of previously conducted laboratory and instrumental research, as well as information about the effect of the disease on the patient's ability to work.

4 . Anamnesis of life

When collecting an anamnesis of life in children, it is necessary to clarify: how the pregnancy proceeded, and the birth of the mother. Than the mother is sick. The baby screamed right after birth or had to be revived. Whether the baby was born on time or is it premature. Whether the childbirth was accompanied by some kind of trauma to the child.

It is necessary to pay attention to whether the newborn child had any diseases and what.

Great attention to devote to the issues of feeding the child, neuropsychic and physical development, a tendency to frequently recurring illnesses in the first year of life and beyond, as well as immunoprophylaxis.

Study: whether he lagged behind peers in physical or mental development.

Find out previously transferred diseases: rickets, infectious diseases, pneumonia, tonsillitis, endocrine diseases, rheumatism, tuberculosis, etc. To clarify whether there were injuries and surgical interventions.

This information is provided in chronological order... The duration and course of diseases, their complications, and the treatment used are indicated.

Living conditions

Characteristics of the dwelling, its living area, water supply, sewerage, heating. The size of the family and its total budget. The nature of the clothes (the widespread use of synthetic fabrics, the manner of dressing too warmly due to an individual habit or a passion for fashion, etc.).

The use of weekends or vacations. Physical education and sports (sports category).

Nutrition: regularity, dry eating, excess food intake. Bad habits: smoking (at what age, how many cigarettes per day).

Use alcoholic beverages(periodically, systematically, in what quantities, since what time).

Tea or coffee abuse. Taking analgesics, sleeping pills, sedatives, drugs and other medications.

Family history

The age and state of health of the parents at the time of the birth of the subject. Diseases of parents, brothers, sisters, uncles and aunts, grandparents, and if they died, then at what age and from what. It is important to keep in mind diseases for which a genetic predisposition is possible, obesity, diabetes, biliously - and urolithiasis disease, blood diseases and neoplasms, arterial hypertension, psychoneurosis and vegetative dystonia, as well as allergic diseases and chronic infections (tuberculosis, toxoplasmosis, syphilis, etc.)

Allergic history

Allergic diseases in parents and close relatives in the past and present. Reactions to the administration of sera and vaccines. How allergic reactions appear, their frequency, how they were stopped.

The main task of an allergic history is to find out the relationship of the disease with a hereditary predisposition and the action of environmental allergens.

Initially, they clarify the nature of the complaints. They can reflect the different localization of the allergic process (skin, respiratory tract, intestines). If there are several complaints, clarify the connection between them. Next, find out the following.

Hereditary predisposition to allergies - the presence of allergic diseases (bronchial asthma, urticaria, hay fever, Quincke's edema, dermatitis) in blood relatives.

Previously suffered allergic diseases (shock, rash and itching of the skin on food, medications, serums, insect bites and others, what and when).

Influence of the environment:

climate, weather, physical factors(cooling, overheating, irradiation, etc.);

seasonality (winter, summer, autumn, spring - exact time);

places of exacerbation (attack) of the disease: at home, at work, on the street, in the forest, in the field;

time of exacerbation (attack) of the disease: day, night, morning.

The influence of household factors:

• contact with animals, birds, fish food, carpets, bedding, upholstered furniture, books;

  the use of odorous cosmetic and washing substances, insect repellents.

Exacerbation connection:

with other diseases;

with menstruation, pregnancy, the postpartum period;

with bad habits(smoking, alcohol, coffee, drugs, etc.).

Connection of diseases with admission:

certain food;

medicines.

Improving the course of the disease with:

elimination of the allergen (vacation, business trip, away, at home, at work, etc.);

when taking anti-allergic drugs.

4. Specific methods of allergological diagnostics

Methods of allergological diagnostics can reveal the presence of an allergy to a particular allergen in a patient. A specific allergological examination is carried out only by an allergist during the period of remission of the disease.

Allergic examination includes 2 types of methods:

provocative tests on the patient;

laboratory methods.

Provocative tests on the patient means the introduction into the patient's body of a minimum dose of an allergen in order to provoke manifestations of an allergic reaction. Carrying out these tests is dangerous, can lead to the development of severe and sometimes fatal manifestations of allergies (shock, Quincke's edema, an attack of bronchial asthma). Therefore, such studies are carried out by a doctor - an allergist in conjunction with a paramedical worker. During the study, the patient's condition is constantly monitored (blood pressure, fever, auscultation of the heart and lungs, etc.).

According to the method of administration of the allergen, there are:

1) skin tests (cutaneous, scarification, pric test, intradermal): the result is considered positive if itching, hyperemia, edema, papules, necrosis appear at the injection site;

2) provocative tests on mucous membranes (contact conjunctival, nasal, oral, sublingual, gastrointestinal, rectal): a positive result is recorded in the event of a clinic of conjunctivitis, rhinitis, stomatitis, enterocolitis (diarrhea, abdominal pain), etc .;

3) inhalation tests - imply the inhalation of an allergen, are used to diagnose bronchial asthma, are positive in the event of an attack of suffocation or its equivalent.

When assessing the test results, the occurrence of common manifestations of the disease is also taken into account - fever, generalized urticaria, shock, etc.

Laboratory tests are based on the determination of antibodies specific to the allergen in the blood, on hemagglutination reactions, degranulation of basophils and mast cells, on antibody binding tests.

5. Urticaria: definition, basics of etiopathogenesis, clinical picture, diagnosis, emergency care.

Hives Is a disease characterized by a more or less widespread rash on the skin of itchy blisters, which are edema of a limited area, mainly of the papillary layer, of the skin.

Etiopathogenesis. Etiological factor can be any allergen (see question 2). Pathogenetic mechanisms - allergic reactions of type I, less often type III. Clinical picture the disease is caused by an increase in vascular permeability with the subsequent development of skin edema and itching due to excessive (as a result of an allergic reaction) release of allergy mediators (histamine, bradykinin, leukotrienes, prostaglandins, etc.)

Clinic... Urticaria clinic consists of the following manifestations.

on skin itching (local or generalized);

localized or generalized itching skin rash with the size of skin elements from 1-2 to 10 mm with a pale center and hyperemic periphery, rarely - with the formation of blisters;

an increase in body temperature up to 37-38 C (rare).

Medical history (see question 3).

Examination - plays an important role in the diagnosis of the disease.

The onset of the disease is acute. A monomorphic rash appears on the skin. Its primary element is a blister. At the beginning, it is a pink rash, the diameter of the elements is 1-10 mm. As the disease progresses (several hours), the blister in the center turns pale, the periphery remains hyperemic. The blister rises above the skin, itches. Less often, elements in the form of vesicles with serous contents are detected (in the case of diapedesis of erythrocytes, with hemorrhagic).

The dermal elements are separated or merged, forming bizarre structures with scalloped edges. Less common rashes on the mucous membranes of the mouth.

An episode of acute urticaria lasts most often from several hours to 3-4 days.

Laboratory and allergological diagnostics- laboratory data are nonspecific, indicate the presence of an allergic reaction and inflammation.

General blood analysis:

slight neutrophilic leukocytosis;

eosinophilia;

acceleration of ESR is rare.

Blood chemistry:

an increase in the level of CRP;

an increase in glycoproteins;

increased seromucoid levels;

an increase in globulin fractions of protein;

an increase in the concentration of class E immunoglobulins.

After stopping the acute phase of the disease, an allergological examination is carried out, which makes it possible to establish the "guilty" allergen.

Urticaria emergency treatment- at acute attack measures should be aimed at eliminating the most painful symptom of the disease - pruritus... For these purposes, it is usually sufficient to use inside (less often - injectable) antihistamines - diphenhydramine, diazolin, fenkarol, tagevil, suprastin, pipolfen and others, rubbing the itchy skin with lemon juice, 50% ethyl alcohol or vodka, table vinegar (9% solution acetic acid), hot shower. The main thing in the treatment of urticaria is the elimination of contact with the allergen.